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Alaska rates for HCPCS 43204

Esophagoscopy Flex Transoral Injection Varices

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,464.00 / $6,782.00 / $13,413.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.38 / $139.79 / $726.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.77 / $268.23 / $462.98
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.51 / $726.34 / $1,016.88
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$325.08 / $503.16 / $928.79
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$374.92 / $624.00 / $1,026.48
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.51 / $726.34 / $1,016.88
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.13 / $495.00 / $901.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.53 / $375.00 / $1,111.14